FULL-LENGTH REPORT Journal of Behavioral Addictions

DOI: 10.1556/2006.7.2018.16

Internet gaming disorder in Lebanon: Relationships with age, sleep habits,

and academic achievement
NAZIR S. HAWI1, MAYA SAMAHA1* and MARK D. GRIFFITHS2

Faculty of Natural and Applied Sciences, Notre Dame University – Louaize, Zouk Mosbeh, Lebanon
1
2
The International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK

(Received: August 2, 2017; revised manuscript received: December 7, 2017; accepted: December 10, 2017)

Background and aims: The latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders
included Internet gaming disorder (IGD) as a disorder that needs further research among different general
populations. In line with this recommendation, the primary objective of this was to explore the relationships
between IGD, sleep habits, and academic achievement in Lebanese adolescents. Methods: Lebanese high-school
students (N = 524, 47.9% males) participated in a paper survey that included the Internet Gaming Disorder Test and
demographic information. The sample’s mean average age was 16.2 years (SD = 1.0). Results: The pooled prevalence
of IGD was 9.2% in the sample. A hierarchical multiple regression analysis demonstrated that IGD was associated
with being younger, lesser sleep, and lower academic achievement. While more casual online gamers also played
offline, all the gamers with IGD reported playing online only. Those with IGD slept significantly less hours per night
(5 hr) compared with casual online gamers (7 hr). The school grade average of gamers with IGD was the lowest
among all groups of gamers, and below the passing school grade average. Conclusions: These findings shed light on
sleep disturbances and poor academic achievement in relation to Lebanese adolescents identified with IGD. Students
who are not performing well at schools should be monitored for their IGD when assessing the different factors behind
their low academic performance.

Keywords: Internet gaming disorder, academic performance, sleep, video game addiction, gaming addiction,
adolescents

INTRODUCTION among older adolescents and emerging adults. For instance,

Since the early 2000s, there has been a significant increase
in the number of studies providing empirical evidence of the
existence of problematic gaming and gaming addiction
(Kuss & Griffiths, 2012). Due to this, the latest (fifth)
edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) included Internet gaming disorder
(IGD) in Section III and stated that IGD is a condition that
requires further study before being included in the main text
(American Psychiatric Association [APA], 2013). With IGD
being a new concept, it is still being debated with many
issues and concerns raised over, whether it is a genuine
disorder or not, and if it is genuine, what criteria are the most
suitable for diagnosis (Kuss, Griffiths, & Pontes, 2017a,
2017b).
Despite the availability of several IGD assessment tools
(Lopez-Fernandez, Honrubia-Serrano, Baguley, & Griffiths,
2014; Pápay et al., 2013; Sanders & Williams, 2016; Wu,
Lai, Yu, Lau, & Lei, 2016), research results collectively
indicated that the IGD is a global phenomenon (Ko, 2014;
Müller et al., 2015; Wittek et al., 2015) with pooled preva-
lence ranging from 1.2% (Rehbein, Kliem, Baier, Mößle, &
Petry, 2015) to 7.6% (Festl, Scharkow, & Quandt, 2013) in
nationally representative samples. Research also appears to
indicate that the highest prevalence rates of IGD are found
in Germany, an IGD prevalence rate of 1.2% was observed
in a representative sample of 11,003 young to older ado-
lescents ranging in age from 13 to 18 years using the Video
Game Dependency Scale (CSAS-II; Rehbein et al., 2015). A
study that included seven European countries reported a
prevalence rate of 5.3% in a sample of 12,938 adult gamers
using the Assessment of Internet and Computer Game
Addiction – Gaming Module (AICA-S-gaming) (Müller
et al., 2015). In Slovenia, an IGD prevalence rate of
2.5% was obtained in a sample of 1,071 gamers aged
13–14 years old using the Internet Gaming Disorder
Scale – Short-Form (IGDS9-SF; Pontes, Macur, & Griffiths,
2016). The Game Addiction Scale (Lemmens, Valkenburg,
& Peter, 2009) was used in European countries reporting an
IGD prevalence rate of 1.4% in a Norwegian representative
sample of 3,035 adult gamers (16–71 years old) (Wittek
et al., 2015) and a rate of 7.6% of problematic users
of ages below 19 years in a German representative sample
of 580 adolescent gamers (Festl et al., 2013). In the
Netherlands, in a nationally representative study of
* Corresponding author: Maya Samaha; Faculty of Natural and
Applied Sciences, Notre Dame University – Louaize, PO Box 72
Zouk Mikael, Zouk Mosbeh, Lebanon; Phone: +961 9 208 749;
Fax: +961 9 225 164; E-mail: msamaha@ndu.edu.lb

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© 2018 The Author(s)

 Hawi et al.

4,559 adolescent gamers aged 13–16 years, a prevalence
rate of 1.5% was reported using the Compulsive Internet
Use Scale (Van Rooij, Schoenmakers, Vermulst, Van Den
Eijnden, & Van De Mheen, 2011). Table 1 includes
these and other selected epidemiological studies that have
investigated IGD.
In addition to prevalence, researchers have been
interested in identifying trends and negative impact of IGD
(Kim et al., 2016; Müller et al., 2015) including academic
achievement, time spent gaming, money spent on gaming,
sleep duration, and impact on job/education and other
leisure activities. A number of studies have demonstrated
the negative impact of gaming on academic achievement
(Van Rooij et al., 2011). For instance, a longitudinal study
of 482 American adolescents with average age of 12 years
reported that video game playing was associated with lower
grade point averages (GPAs; Jackson, Von Eye, Witt, Zhao,
& Fitzgerald, 2011). Recent studies have confirmed this
finding from many parts of the world including Germany
(Rehbein et al., 2015), Taiwan (Yeh & Cheng, 2016),
Lebanon (Hawi & Samaha, 2016), Norway (Brunborg,
Mentzoni, & Frøyland, 2014), Iran (Haghbin, Shaterian,
Hosseinzadeh, & Griffiths, 2013), and the United States of
America (USA) (Schmitt & Livingston, 2015; Wentworth &
Middleton, 2014).
As for time spent gaming, a study conducted in Hong
Kong on a sample of 503 adolescents showed that of total
gamers, 22.9% and 36.6% played more than 3 hr on week-
days and weekends, respectively, and 31.2% and 32% played
more than 1 hr on weekdays and weekends, respectively
(Wang et al., 2014). Studies also report that gamers tend
to play online games rather than offline. For instance, the

Table 1. International comparison of prevalence rates of video game addiction/Internet gaming disorder
Nationally
Sample Prevalence representative
Reference Scale used size Age rate (%) Country sample
Pontes, Macur, and Internet Gaming Disorder 1,071 M = 13 2.5 Slovenia Yes
Griffiths (2016) Scale – Short-Form (IGDS9-SF)
Fuster et al. (2016) Spanish version IGD-20 Test 1,074 12–58 2.6 Spain No
Pontes and Griffiths IGDS9-SF 509 10–18 Not Portugal No
(2016) available
Khazaal et al. (2016) 7-item Game Addiction Scale (GAS) 5,983 M = 20 2.3 Switzerland No
Kim et al. (2016) The suggested wordings of the DSM-5 3,041 20–49 13.8 Korea No
criteria was applied
Rehbein et al. (2016) Gaming usage and time questions 3,073 M = 49 4.2 Germany Yes
Lemos, Cardoso, Video Game Addiction Test (VAT) 384 18–24 Not Brazil No
and Sougey (2016) available
Rehbein et al. (2015) CSAS-II 11,003 13–18 1.16 Germany Yes
Wittek et al. (2015) 7-item Game Addiction Scale for 3,035 16–74 1.4 Norway Yes
Adolescents (GAS)
Müller et al. (2015) Assessment of Internet and Computer 12,938 14–17 1.6 7 European Yes
game Addiction–Gaming Module countries
(AICA-S-gaming)
Pontes et al. (2014) Internet Gaming Disorder Test 1,003 16–58 5.3 57 No
(IGD20-Test) countries
Lopez-Fernandez Problematic Videogame Playing Scale 1,132 11–18 7.7 Spain No
et al. (2014) 1,224 14.6 Great
Britain
King, Delfabbro, Pathological Video Gaming (PVG) 1,287 12–18 1.8 Australia No
Zwaans, and
Kaptsis (2013)
Spekman, Konijn, Problematic gaming behavior 1,004 11–18 8.57 Netherlands No
Roelofsma, and
Griffiths (2013)
Festl et al. (2013) 7-item Game Addiction Scale for 580 14–18 7.6 Germany Yes
Adolescents (GAS)
Brunborg et al. Game Addiction Scale for Adolescents 1,320 M = 13.6 4.2 Norway Yes
(2013) (GASA)
Van Rooij et al. Compulsive Internet Use Scale (CIUS) 4,559 13–16 1.5 Netherlands Yes
(2011)
Choo et al. (2010) Pathological Video Gaming Scale 2,998 M = 11.2 8.7 Singapore No
Grüsser, Adapted from WHO criteria for 7,069 21.1 11.9 Germany No
Thalemann, and substance dependence
Griffiths (2007)
Johansson and Internet Addiction Test 3,237 12–18 2.7 Norway Yes
Götestam (2004)

Journal of Behavioral Addictions

 IGD in Lebanon: Sleep and academic achievement
aforementioned Hong Kong study reported that (a) playing
online multiplayer games was the most preferred type of
game, (b) online single player games ranked second, and
(c) a minority preferred playing offline casual games (Wang
et al., 2014). Online gaming can result in extended periods of
gaming for which a small minority can be problematic and
addictive. In addition, evidence suggests that some game
genres are more addictive than others, such as role-playing
games and first-person shooter games (Festl et al., 2013;
Lemmens & Hendriks, 2016; Na et al., 2017; Rehbein, Staudt,
Hanslmaier, & Kliem, 2016; Sanders & Williams, 2016).
Excessive online gaming has also been shown to reduce
gamers’ sleep duration and/or result in deteriorating sleep
quality (Demirci, Akgönül, & Akpinar, 2015; Rehbein et al.,
2015), especially in adolescents (Achab et al., 2011; Arora,
Broglia, Thomas, & Taheri, 2014; Lam, 2014). A recent
study reported that 28% of participants with sleep problems
have IGD (Satghare et al., 2016). The authors’ follow-up of
some gamers suggest that they stay awake longer than the
recommended sleep guidelines or awake early from sleep to
continue playing either to advance to the next level in the
game, to simply sustain the current game level, and/or for
pleasure. Furthermore, some studies have reported that
gamers spend varying amounts of money to purchase
additional lives, cheats, virtual weapons, gadgets, and/or
accessories to gain advantage or just for the fun of game
playing (Cleghorn & Griffiths, 2015). In the sample of the
aforementioned Hong Kong study, around 40% reported
having spent money on gaming, of which 3.6% spent above
US $65, and 9.9% spent between US $25 and $64, monthly
(Wang et al., 2014). In addition, it has also been noted in
many studies that gender (being male) and age (being
younger) correlate with the IGD (Hawi & Rupert, 2015;
Hawi & Samaha, 2017a, 2017b; Rehbein et al., 2016;
Samaha & Hawi, 2017; Wittek et al., 2015).
The aim of this study was to explore the extent to which
age, sleep habits, and academic achievement explain a
statistically significant amount of variance in IGD among
high-school adolescents (Griffiths, 2014) in a population
that has never been previously studied (i.e., Lebanese teen-
agers). Another aim was to determine the prevalence of IGD
in the study’s Lebanese sample and identify variables
associated with IGD to contribute to knowledge in this field
of study as recommended by DSM-5 (APA, 2013). Despite
the influence of external factors, such as the Lebanese
culture and political environment, a better understanding
of the predictors of IGD in different cultures is another step
toward helping those who provide treatment and rehabilita-
tion for those with clinically significant impairment
(Griffiths, 2014; Petry & O’Brien, 2013).
METHODS
Participants and procedure
The present investigation was a cross-sectional study
carried out in 2016 at 10 Lebanese high schools based on
voluntary participation of students. A total of 2,096
students from grades 10, 11, and 12 (aged 15–19 years)
received the questionnaire (mean age = 16.2 years,
SD = 1.0). Participation in the survey was purely voluntary
and the overall response rate was 25%, yielding an adequate
sample size (524 participants). There was a lower ratio of
male (47.9%) to female respondents. Participants were
recruited from 10 schools operating in different administra-
tive governorates across Lebanon. Schools where English
was a medium of instruction were targeted (because the
survey was in English). Following the school’s approval to
collect the data, the “pen and paper” survey was administered
in classrooms in the presence of class instructors.
Measures
The survey questionnaire was self-report, in English, and
handed out on paper copy. It included two sections. The first
section collected demographic information, including parti-
cipant’s age, gender, grade average, starting age of Internet
gaming, amount of time spent gaming online and offline on
weekdays and weekends, typical sleep duration and whether
the individual woke up during the night to continue gaming,
and money spent on Internet gaming.
The second section included the Internet Gaming Disor-
der Test (IGD-20 Test; Pontes, Kiraly, Demetrovics, &
Griffiths, 2014). This scale reflects the nine criteria of IGD
as stated in the DSM-5 and incorporates the theoretical
framework of the components model of addiction (Griffiths,
2005). It is a validated and well-established scale that has
been used in many studies and translated to Spanish,
Portuguese, and Arabic (Fuster, Carbonell, Pontes, &
Griffiths, 2016; Hawi & Samaha, 2017c; Pontes & Griffiths,
2016). Participants rated the 20 items on a 5-point Likert
scale: 1 (“strongly disagree”), 2 (“disagree”), 3 (“neither
agree nor disagree”), 4 (“agree”), and 5 (“strongly agree”).
In the process of validating IGD assessment scales and
particularly the assessment of criterion-related validity, the
association between scale score and time spent gaming time
was analyzed (Donati, Chiesi, Ammannato, & Primi, 2015;
Festl et al., 2013). In the study conducted by Pontes, Kiraly,
Demetrovics, and Griffiths (2014), which included 57
countries, the IGD-20 Test scores positively and strongly
correlated with weekly gameplay time (r = .77, p < .001).
A similar result was recently obtained in Spain (r = .42,
p < .01) (Fuster et al., 2016) and Portugal (r = .36, p < .01)
(Pontes & Griffiths, 2016). In this study, the IGD-20
Test scores positively and strongly correlated with weekly
gameplay (r = .58, p < .001). In addition, in this study, the
IGD-20 Test demonstrated excellent internal consistency
(Cronbach’s α = .915).
Analysis
Data analyses were performed using SPSS 20.0 (SPSS,
version 20.0 Chicago, IL, USA). The major aim of this
research was analyzed using hierarchical multiple regres-
sion. Prior to regression analyses, preliminary analyses
were first conducted to ensure that there was no viola-
tion of the assumptions of normality, linearity, multi-
collinearity, and homoscedasticity. No violations were
found. In addition to regression analysis, descriptive
statistics and Pearson product moment correlations were
carried out.
Journal of Behavioral Addictions
 Hawi et al.

Ethics Prevalence and patterns in Internet gaming

Following the approval of the Research Ethics Committee at
Notre Dame University, Louaize, the research study was
conducted including the distribution of the survey question-
naire to schools. After receiving written informed parental
consent, students were allowed to fill the questionnaires on a
voluntary basis.
RESULTS
The sample’s mean average age was 16.2 years (SD = 1.0).
The average number of years that participants reported
online gaming was 7.75 years (SD = 2.9). Participants were
classed into three groups. The following notations are used
to distinguish between the three different groups studied:
Internet Gaming Disorder Group (IGDG; scoring 71 or more
on the IGD-20), at-risk of IGDG (RIGDG; scoring between
50 and 70 on the IGD-20), and casual gaming group (CGG;
scoring below 50 on the IGD-20) representing those who
did not meet IGD criteria.
A total of 98.0% of participants used more than one platform
for online gaming, and 61.3% used three or more platforms.
As assessed by the IGD-20 Test, 9.2% of respondents
belonged to the IGDG, 35.7% to the RIGDG, and 55.1%
to the CGG. The average daily playtime of gamers in this
study was 2.2 hr/day. It is noteworthy that the average
gaming time spent online doubled on weekends compared to
weekdays within all three groups. In addition, the maximum
number of hours gaming online increased from 7 hr/day on
weekdays to 14 hr/day on weekends. Among groups, the
average time spent gaming online on weekdays increased
from 1.7 hr/day within the CGG to 2.5 hr/day within the
RIGDG to 3.6 hr/day within the IGDG. In addition, the
average time spent gaming online at weekends followed a
similar pattern (Table 2). Furthermore, results showed that
the percentages of respondents, in both the IGDG and the
RIGDG, within grades 10, 11, and 12, were 50.0%, 34.1%,
and 15.9%, respectively. The higher the grade level, the
lower the percentage of participants with IGD.

Table 2. Prevalence and trends of predictors of IGD in Lebanese high-school students (N = 524)
IGDG RIGDG CGG Total
%
Prevalence 9.2 35.7 55.1 100
Hours/day
Average Internet gaming playtime
Weekdays (SD) 3.6 (1.9) 2.5 (1.4) 1.7 (1.2) 2.2 (1.4)
Weekends (SD) 8.1 (3.8) 5.9 (3.5) 3.4 (2.1) 4.7 (3.3)
%
Offline versus online Internet gaming playtime (within group)
Offline 11.1 42.9 53.7 45.9
Online 88.9 45.7 38.9 45.9
Both 0.0 11.4 7.4 8.2
Hours/night
Sleep duration (SD) 4.9 (2.7) 6.9 (1.6) 7.1 (1.5) 6.9 (1.7)
%
Sleep disturbance (within group)
Sometimes 100.0 42.9 13.0 31.6
Never 0.0 57.1 87.0 68.4
$
Monthly spending on Internet gaming
Average (SD) 74.4 (110.3) 20.25 (25.9) 12.4 (40.1) 21.9 (51.5)
Range 0–350 0–100 0–250 0–350
Grade point average out of 20
Academic achievement
Average (SD) 10.5 (3.1) 12.1 (3.2) 13.4 (2.8) 12.7 (3.1)
%
Platforms of Internet gaming (within group)
Mobile phones 88.9 97.1 87.0 90.8
Computers 55.6 71.4 63.0 65.3
Game consoles 55.6 65.7 66.7 65.3
Tablets 33.3 68.6 64.8 63.3
Note. SD: standard deviation; IGDG: group of participants identified with Internet gaming disorder; RIGDG: group of participants identified
at-risk of Internet gaming disorder; CGG: Group of participants identified as casual players.

Journal of Behavioral Addictions

 IGD in Lebanon: Sleep and academic achievement

The average time spent online gaming of the CGG
increased from 1.7 hr/day on weekdays to 3.4 hr/day on
weekends. The average time spent online gaming at week-
ends of the CGG (3.4 hr/day) matched that of IGDG on
weekdays (3.4 hr/day). At first glance, it is tempting to
conclude that some CGG gamers on weekends should be
classified as IGDG. However, the time spent online gaming
was not strongly correlated with IGD, otherwise participants
from the CGG who played as much as IGDG would have
been identified with IGD using the IGD-20 Test. CGG
participants who doubled their time spent online gaming at
weekends did so for entertainment purposes and not con-
trolled by disorder criteria as it is the case with the IGDG.
Table 2 shows a clear change in the pattern of offline and
online usage. More gamers within the CGG played offline,
whereas gamers in the RIGDG played online rather than
offline. Eight times as many gamers in the IGDG played
online rather than offline, and none in the IGDG played
offline games at all. With regard to sleep duration, the average
number of hours of sleep per night was 7.1 hr within the CGG
and 4.9 hr within the IGDG. The results also found that
13.0% of the CGG gamers woke up from their sleep during
the night to continue gaming compared with 42.9% of the
RIGDG gamers and 100.0% of the IGDG. In addition, the
average monthly spending on Internet gaming rose from US
$12.40 within the CGG to US $20.25 within the RIGDG, and
to US $74.40 within the IGDG. GPA (of over 20) went down
to 13.4 within the CGG, to 12.1 within the RIGDG, and to
10.5 within the IGDG (Table 2).
Relationship between IGD, gender, age, sleep habits, and
academic achievement
The sample size was adequate for hierarchical regression
analysis as only five independent variables were investi-
gated (Tabachnick, Fidell, & Osterlind, 2001). None of
the independent variables correlated, except for a weak
association between gender and sleep disturbance. The col-
linearity statistics tolerance and variance inflation factor (VIF)
were within accepted limits indicating that there was no
multicollinearity among factors. More specifically, tolerance
values ranged between 0.90 and 0.96, and VIF values
ranged between 1.0 and 1.1 (much below the threshold 3).
Consequently, the assumption of multicollinearity was met
(Coakes, 2005). In addition, the Mahalanobis distance scores
indicated that there were no multivariate outliers. Moreover,
residual and scatter plots indicated that the assumptions of
normality, linearity, and homoscedasticity were all met (Hair,
Black, Babin, Anderson, & Tatham, 1998). Following this, a
four-stage hierarchical multiple regression was carried out to
assess the extent to which gender, age, sleep duration, sleep
disturbance, and academic achievement predicted levels of
IGD among the participants (as assessed using the IGD-20).
Gender was entered at step 1 of the regression, age was entered
at step 2, sleep duration and sleep disturbances at step 3, and
academic achievement at step 4. The regression analysis results
are reported in Table 3. The hierarchical multiple regression
demonstrated that at step 1, gender was not a significant
contributor to the regression model, although it accounted for
3.5% of the variation in IGD (Table 3). Introducing age
explained an additional 16.5% of the variation in IGD, and
this change in R2 was significant [F(1, 522) = 6.201, p < .05].
Adding sleep duration and sleep disturbance to the regression
model explained an additional 23.3% of the variation in IGD
and this change in R2 was also significant [F(3, 520) = 10.816,
p < .001]. Finally, the addition of academic achievement to
the regression model explained an additional 9.0% of the
variation in IGD and this change in R2 was again significant
[F(4, 514) = 12.804, p < .001]. In sum, four predictors (age,
sleep duration, sleep disturbance, and academic achievement)
together accounted for an additional 48.8% of the variance in
IGD after controlling for gender. The beta values for sleep-
related measures were higher than age and academic achieve-
ment, with sleep disturbance having the greatest influence on
IGD (Table 3). Results demonstrated that the risk of IGD in
adolescence was increased by being younger, having lower
academic achievement, having lower sleep duration, and
waking up more during the night to continue gaming.

Table 3. Hierarchical multiple regression of predictors of Internet Gaming Disorder in Lebanese high-school students (N = 524)
Predictor variables β t R R2 R2 ΔF
Step 1 .035 .001 −.005 0.199
Gender −0.035 −0.446
Step 2 .200 .040 .040 6.201*
Gender −0.025 −0.310
Age −0.199 −2.490*
Step 3 .433 .187 .187 10.816***
Gender 0.020 0.245
Age −0.244 −3.032**
Sleep duration −0.212 −2.766**
Sleep disturbance 0.346 4.376***
Step 4 .523 .274 .274 12.804***
Gender 0.101 1.330
Age −0.218 −2.850**
Sleep duration −0.212 −2.766**
Sleep disturbance 0.346 4.376***
Academic achievement −0.183 −2.455*
Note. *p < .05. **p < .01. ***p < .001.

Journal of Behavioral Addictions

 Hawi et al.
DISCUSSION
This study examined the relationships between IGD and
other variables (age, sleep-related factors, and academic
achievement) among Lebanese adolescents. The results
showed that 9.2% of the study’s sample were classed as
having IGD using the IGD-20 Test. The prevalence of IGD
in this study is above midrange among those reported in
other studies (Table 1), with a range between 1.2% in
Germany (Rehbein et al., 2015) and a 14.6% in the United
Kingdom (Lopez-Fernandez et al., 2014). One possible
reason for the high prevalence rate of IGD may have been
due to the age of the sample, because IGD appears to be
more prevalent among older adolescents and emerging
adults (Griffiths, Kuss, & Pontes, 2016). This variance in
studies’ results may also be explained by one or more of the
following: (a) use of different scales to assess the IGD
(Griffiths, 2014; Kim et al., 2016; Király, Nagygyörgy,
Griffiths, & Demetrovics, 2014; Schmitt & Livingston,
2015); (b) use of same scale, but using different cut-off
thresholds (Rehbein et al., 2015); (c) employment of differ-
ent sampling procedures (Sanders & Williams, 2016);
(d) selection of samples differing in their characteristics
(Rehbein et al., 2015; Sanders & Williams, 2016; Wentworth
& Middleton, 2014); and/or (e) collection of data at different
times of the year (Griffiths, 2014; Kim et al., 2016).
Similar to many studies, the study’s sample included
more gamers classed as at-risk of IGD (RIGD) (35.7%) than
gamers classed with IGD (9.2%) (Müller et al., 2015; Wittek
et al., 2015). While the average daily playtime of gamers in
this study (2.2 hr/day) was very close to that of a Portuguese
sample (Pontes & Griffiths, 2016), it was lower than that of a
Singaporean sample (2.9 hr/day) (Choo et al., 2010),
but higher than that of a German sample (1.6 hr/day)
(Rehbein et al., 2015). The IGDG’s average daily playtime
(8.1 hr/day) was much higher than that of a German sample
(6.3 hr/day) (Rehbein et al., 2015). Similar to this study, an
investigation conducted on a South Korean sample reported
that the those with IGD spent more hours a week gaming
compared with all the rest (Kim et al., 2016) and the average
time spent gaming doubled at weekends for all subgroups
within the sample (Hawi, 2012). It is worth noting that this
study was conducted in May, which was toward the end of
the school year, with a noticeable increase of homework and
exams. It was anticipated that the amount of time spent
gaming would be much higher during holidays and summer
vacation. As the data were collected during school days, the
only period for participants to carry out their gaming was
before and after school. In addition, massively multiplayer
games involves gamers from different time zones to keep
building their characters, which can lead to sleep deprivation
(Achab et al., 2011) with some gamers who avoid logging
off and become preoccupied with minimizing possible
losses. Probably for the aforementioned reasons, all gamers
assessed with IGD reported that sometimes they woke up
during the night to continue gaming online (Rehbein et al.,
2015). This result confirms previous studies that reported
gaming addicts refrain from sleeping to gain more time in
the virtual world (Bartel & Gradisar, 2017; Lam, 2014;
Satghare et al., 2016; Young, 2009).
Journal of Behavioral Addictions
In this study, the school GPA of the IGD group (Table 2)
was below the passing grade and much lower than the GPAs
of those RIGD and the CGG. Other studies have reported that
participants with IGD had poorer academic achievement in
Singapore (Choo et al., 2010), USA (Jackson et al., 2011),
Norway (Brunborg et al., 2014), and Germany (Rehbein et al.,
2015). This finding is likely explained by the large amount
of time spent allocated to gaming (Kuss & Griffiths, 2012)
especially during study days, which in turn may lead to
lack of in-class concentration due to sleep deprivation
(Ko, 2014). This study found that 92.3% of participants
with IGD reported that they are preoccupied with Internet
gaming, and of these participants, 75% reported that they
wake up during the night to continue gaming. This state of
mind, whereby a gamer is either gaming or thinking about
gaming all the time, can in some cases lead to neglect of
day-to-day responsibilities at school and home. Sleep-
deprived participants, whether in quantity or quality,
cannot focus on their studies and are therefore unable to
learn efficiently. This phenomenon builds upon existing
studies showing how academic achievement is negatively
affected by different technological addictions (Samaha &
Hawi, 2016) and in particular by the excessive gaming
(Jackson et al., 2011). Finally, the percentage of gamers
who played online in this study’s sample (45.9%) was
lower than that of a similar Canadian sample (52.8%)
(Sanders & Williams, 2016).
Limitations and recommendations
The main limitations of this study were its cross-sectional
design, the use of a non-representative sample, the use of
Lebanese schoolchildren only, and the use of self-report
data. All of these methodological issues have well-known
biases (e.g., social desirability bias and recall bias) and
shortcomings (e.g., non-generalizability to other samples
and cultures). Another limitation is that the IGD-20 Test was
developed and validated using a young adult sample and not
on older adolescents. The use of a scale developed for adults
may have affected the prevalence scores when used by older
age adolescents. In future studies, a scale designed specifi-
cally for adolescents would be of benefit to overcome this
limitation. All studies cited in this paper also used cross-
sectional design for its practicality and convenience (as was
the case in this study); therefore, longitudinal studies are
needed to determine the causal relationships between the
different variables, as such associations found in this and
other studies can go in both directions. In particular, evi-
dence is needed to determine whether IGD causes low
academic achievement or vice versa. It should also be noted
that the response rate was low (25%) and this also needs
taking into account when considering the results. The low
response rate may have been because (a) participation was
purely voluntary, and/or (b) the English language skill
among students was not sufficient to answer the survey
questions. Finally, future research should target adolescents
from various cultures preferably different countries and
compare results. However, this study adds to the literature,
because it is one of the very few to be carried out in
Lebanon.
 IGD in Lebanon: Sleep and academic achievement
CONCLUSIONS
The DSM-5 introduced IGD as a condition for further study
(APA, 2013) and suggested nine criteria for its diagnosis.
Using a psychometrically robust scale incorporating these
nine criteria, this study provided insight into the field of IGD
by examining a sample of Lebanese adolescents in relation to
prevalence and potential predictors of IGD. Assessment using
the IGD-20 showed that the prevalence of IGD was 9.2% in
the study’s population sample. Furthermore, the study iden-
tified some key predictors of IGD including being a younger
adolescent, sleeping less, waking up from sleep more during
the night to continue playing, and poor academic achieve-
ment. These empirical research findings suggest factors that
might guide early detection and prevention of IGD.
Funding sources: This research was supported by a grant
from the National Council for Scientific Research (CNRS) –
Lebanon (grant 3661/S).
Authors’ contribution: NSH and MS contributed to the
study concept and design. MS contributed to the collection
of data and literature review. NSH contributed to the
interpretation of data and the statistical analysis and
obtained funding. MDG contributed to the supervision of
the study, interpretation of the data, and drafting of the
manuscript.
Conflict of interest: No competing financial interests exist.
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